Zeitschrift für klinische Fallberichte

Background: Bicycle accidents are a significant cause of traumatic morbidity in the paediatric population. The handlebar injuries are usually isolated and remain a major source of bicycle related morbidity. We present a case of severe liver laceration with left hepatic duct transection caused by handlebar trauma in a 13-year-old boy. Case presentation: An otherwise healthy 13-year-old Caucasian male patient was rushed to the hospital following a blunt abdominal trauma from a bicycle handlebar. An ultrasound finding of extensive free intraperitoneal fluid with accompanying features of hemodynamic instability necessitated a decision to perform an emergency exploratory laparotomy. Operative findings included massive haemoperitoneum, a deep laceration almost separating left and right liver lobes, and a near-complete interruption of the left hepatic duct. Interestingly, the vascular anatomy of the left liver lobe was preserved. Surgical haemostasis was successfully accomplished, and a duct-to-duct anastomosis of the ruptured left hepatic duct was performed. A T-tube biliary drainage was inserted, and intraoperative cholangiography showed no extraluminal spillage of contrast. During the recovery phase, cholangiography was performed several times revealing leakage from left hepatic duct. The leakage was managed conservatively and finally stopped. The boy was eventually discharged home in stable clinical condition. Conclusion: Management of blunt hepatic injuries has remarkably changed from mandatory operation to mostly non-operative interventions with selective operative management. Hemodynamic instability remains the main reason for exploratory laparotomy. Near-isolated laceration of main hepatic ducts is an extremely rare surgical finding, and immediate reconstruction is the best option if an experienced surgeon is available. Additionally, even though biliary leakage was observed after the operation, conservative treatment with T-tube left in place for a considerably long period was successful.

Aims and objectives: To detect super numeracy tooth in nasal cavity. Introduction: The ectopic dentition present in intranasal area is very rare finding clinically. It is very difficult to make proper diagnosis of such condition. Teeth is present in ovaries, testes and pre-sacral regions. The presence of teeth in maxillary sinus, mandibular condyle, chin, nose and orbit in maxillofacial region is also observed. Case Report: Prospective cross-sectional study was conducted. Anterior microscopy was done; proper detection of supernumerary tooth was carried out. Result: A 21-year-old female patient presented with complaints of intermittent right sided epistaxis. She had history of occasional headache for 6 months. An anterior rhinoscopic examination revealed a hard white-mass which is peripherally surrounded by granulation tissue that lies in floor of the right-nasal cavity. It’s appearance clinically was of a rhinolith. Conclusion: Super-numerary teeth are observed extra to normal complement indentition. They may occur unilaterally or bilaterally, single or multiple. A variety of complications can occur that may be crowding or cyst formation. There by, identifying early and also treatment are useful for management.

A 42-year-old, previously healthy woman, admitted to our emergency department with first episode of severe
dyspnea and chest pain, hemodynamically stable. She has no history of previous cardiovascular or respiratory
disease, no history of PE or DVT. She had elevated D-dimers. Urgent echocardiography showed indirect signs of
PE, which was confirmed by pulmonary artery CT angiography, which showed massive PE. After two days of heparin
infusion she developed hemodynamic instability with cardiogenic shock, treated successfully with fibrinolysis. The
thrombophilia profile was done two weeks after stopping therapy with rivaroxaban after six months. Thrombophilia
panel came back positive for high levels of homocysteine (67 μmol/L), with other thrombophilia results within normal
limits. Pulmonary embolism should be always suspected in younger patients with acute severe dyspnea event without
provocable risk factors. High suspicion level and fast diagnosis are lifesaving. In younger patients presenting with
unprovoked pulmonary emboli, clinicians should consider inherited prothrombotic factors and homocystinemia as a
potential cause. Longer anticoagulation therapy should be considered in these cases with novel oral anticoagulants
as recommended safer and superior therapy.

Background: Cutaneous Squamous Cell Carcinoma (cSCC), is one of the major types of skin cancer, along with basal cell cancer and melanoma. It usually presents as a hard lump with a scaly top but can also form as an ulcer. The greatest risk factor is high total exposure to ultraviolet radiation from the sun. Squamous cell carcinomas are generally treated by surgical excision, Mohs surgery or electrodessication and curettage. Non-surgical options for the treatment of cSCC include topical chemotherapy, topical immune response modifiers, Photodynamic Therapy (PDT), radiotherapy, and systemic chemotherapy. Patient and Methods: The patient was a 92-year old female with cSCC at the left side of frontal bone, which was removed a few times by surgery. In July 2018, a last attempt at removal was made, R2 resection with penetration versus meningeal tissue. She was irradiated in this area with 70Gy, achieving reduction of the tumor mass and relief. In May 2018, upon tumor progression, cemiplimab (Libtayo) treatment was suggested. Results: After 6 cycles of treatment, more than 50% tumor reduction (as shown by MRI) was seen, along with partial healing of wounds caused by bone destruction. Adverse effects appeared with a cutaneous rash, Grade IV, after the 5th cycle, treated successfully with prednisone. Conclusion: The use of Cemiplimab is safe and effective and needs to be considered as a first-line treatment in such cases.

Pheochromocytomas (PCC) are rare neuroendocrine tumors of the medulla of adrenal glands. Malignant pheochromocytomas are even rarer and forming 10-25% of all PCC. The only criterion to establish malignant behaviour being distant metastasis to site without chromaffin tissue. We report an exceptional case of metachronous intracranial metastasis of pheochromocytoma to the clival bone in a 59-years-old patient. The patient was managed surgically for a wright adrenal pheochromocytoma ten years before. Only six cases of intracranial metastasis of pheochromocytoma have been reported in the literature, and to the best of our knowledge, this is the seventh case and the first clival bone metastasis of this rare condition.

Objective: The rehabilitation of a patient recovering from a coma is a serious challenge in clinical practice. The aim of this study was to present the feasibility of using modern devices in rehabilitation for a patient in a vegetative state. Case report: The studies involved a 48-year-old female patient who at the age of 47 suffered an intracerebral haemorrhage. The patient, for 12 months, was in the stationary ward, and from Monday till Friday underwent a rehabilitation program including individual therapies, Erigo and Lokomat. A functional study included: measurements of the passive range of motion of the upper and lower limbs, angle of catch, the Modified Ashworth Scale and the Glasgow Coma Scale. Results: Proposed treatment had an impact on reducing the severity of the coma, improving the range of motion, decreasing the angle of catch, spasticity reduction and the patient’s independence in terms of maintaining the head while sitting. Conclusion: The combination of Erigo and Lokomat with conventional therapy, in the case of patients in the vegetative state, allows the maintenance of proper ranges of motion, prevention of oedema, maintenance of proper limb circumferences, improvement of orthostatic reactions and reduction of spasticity.

Tuberculosis (TB), as a kind of chronic infectious disease by Mycobacterium Tuberculosis (Mtb), is one of the most common causes of death worldwide. The strategy of anti-TB therapy has improved during the last decades following the development of agents against TB and advanced exploration of TB. However, accompanied with the medical progression, Multidrug-Resistant TB (MDR-TB) has also emerged which causes higher mortality and morbidity due to multiply factors from clinical treatment, epidemiology and compliance of patients including drug abusing, irregular schedules and gene mutations. Therefore, we present a case of TB with rifampin-resistance in this article to explore risk factors of drug-resistance.